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GLP-1s and workforce health: Obesity, Ozempic, and overwhelming unknowns

GLP-1s like Ozempic and Wegovy have been hailed as game-changers in the fight against obesity. They’re hot topics in health care and pop culture — and with 42% of Americans living with obesity, demand is soaring.1 But these drugs come with sky-high price tags of up to $1,349 per month. Business leaders need to examine the costs and benefits to determine when — and how — to cover GLP-1s.2

Most employers cover these drugs to treat type 2 diabetes, but many are hesitant to cover them for obesity. Years of evidence prove that GLP-1s are safe and effective in lowering blood sugar and decreasing risk for comorbidities in patients with type 2 diabetes — but it’s too soon to know how short-term benefits stack up against potential long-term consequences when used to treat obesity alone. And there’s growing concern about viewing GLP-1s as silver bullets to solve America’s obesity problem — which could be costly and unsustainable at best, and dangerous at worst.

What we do know for sure is that they need to be prescribed responsibly, by doctors who are invested in their patients’ physical, mental, and social health. And business leaders can play an integral role in making that happen.

GLP-1s for obesity: Promising results — and a lot of unknowns

GLP-1s may be new to mainstream media, but they’re not new to the health care industry. The first one was approved by the FDA in 2005 to treat type 2 diabetes.5 Over time, researchers observed side effects — namely, decreased appetite and weight loss. Fast-forward to today, and millions of people are using GLP-1s to lose unwanted pounds. Prescriptions increased 300% between Q1 2020 and Q4 2022 — and now only 54% are prescribed to treat type 2 diabetes.6

People can lose 15% to 20% of their body weight on GLP-1s7

That kind of weight loss can help employees manage — and even reverse — many chronic diseases that go beyond diabetes, including high cholesterol, high blood pressure, and more.

There’s growing concern about negative — and unknown — impacts

Despite the overwhelming demand for new GLP-1 prescriptions for weight loss, more than 2 in 3 people stop taking them within the first year.9

  • More than 82% experience mild to moderate gastrointestinal side effects.10
  • Users have 4 times greater risk for stomach paralysis and bowel obstructions and 9 times greater risk for pancreatitis.11
  • Up to 40% of the weight people lose on GLP-1s is actually lean muscle mass, not fat.12
  • Researchers are looking into the possibility that GLP-1s could increase depression and risk for suicide in some patients.13

“We have a pretty good understanding of the short-term consequences of GLP-1s for weight loss. But long term, we really don’t know. And that’s where my concern lies,” says Sean Hashmi MD, MS, FASN — regional physician director of lifestyle and obesity medicine at Kaiser Permanente. “For example, in patients who rely on food for comfort, taking a GLP-1 blocks those reward pathways in the brain, and they could become depressed.”

Employees may need to take GLP-1s for life to maintain results

While we know that GLP-1 therapy is cost-effective for treating type 2 diabetes, it’s still unclear if using it to treat obesity makes good business sense.16 Considering how costly GLP-1s are, employers are right to be concerned about the potential financial impact of covering them for weight loss — especially since people who stop taking them regain 2/3 of the weight they lost within a year.17 “These are not drugs employees should take for a few months to lose a few pounds,” explains Dr. Hashmi. “When people stop taking them, their appetite comes back with a vengeance — along with excess weight.”

Are GLP-1s being prescribed safely and responsibly?

We clearly don’t know enough about GLP-1s for weight loss yet to prescribe them to everyone who wants them — but everyone seems to want them. In fact, 3 in 5 Americans trying to lose weight are interested in taking GLP-1s.18 And as employers struggle to balance workforce demand with responsible benefits spending, GLP-1s are emerging as a powerful recruitment and retention tool:

  • Twenty percent of employees would change jobs to get GLP-1 coverage.19
  • Employees rank GLP-1 coverage as more important than other highly coveted benefits, like child care reimbursement, unlimited paid time off, and flexible work arrangements.20

Questions about supply, demand, ethics, and equity

Ongoing shortages have raised questions about who should have access to GLP-1s — and ensuring availability for people who truly need them. But many virtual, direct-to-consumer companies are aggressively marketing GLP-1s for weight loss and selling prescriptions with little, if any, medical oversight. In fact, only 53% of new GLP-1 prescriptions in the U.S. are associated with a doctor visit.1

Experts also worry that the media frenzy surrounding these drugs could be harmful to people with eating disorders by reinforcing cultural ideals around thinness. And finally, most employees can’t afford to pay for these expensive drugs out of pocket, which could eventually widen the health equity gaps we already see around obesity.

How to build GLP-1s into your workforce health strategy

Obesity is a complex, chronic disease. There’s no one cause, and no single solution.

Understanding your health plan’s GLP-1 cost-containment strategy is the first step — but employers also need to proactively balance emerging science with evidence-based interventions and smart business decisions. Here are some ideas to help you do that.

Provide comprehensive weight management support

GLP-1s should never be the first line of defense for weight management and should only be considered in conjunction with personalized physical, mental, and social health support. This could include things like counseling, nutrition education, digital tools, employee support groups, and subsidized fitness classes.

As Dr. Hashmi notes, “These medications are not substitutes for eating better, exercising, managing stress, and prioritizing sleep.” Considering the low adherence and high cost associated with GLP-1s, behavior and lifestyle modifications remain essential to the long-term value of any workforce weight loss strategy.

Choose a health plan with a targeted prescribing approach

Before considering GLP-1 medications, physicians should carefully review each employee’s medical history to understand how weight has impacted their health — and what solutions have been explored before. Then, they should work together to create a holistic and sustainable treatment plan that addresses behavior changes, psychosocial support, and socioeconomic stressors — and may or may not include medication.

Advocate for equitable, evidence-based care

Ask your health plan how their physicians approach GLP-1s. Make sure these drugs are being prescribed to employees with type-2 diabetes and comorbidities, not just those with obesity. And — although this should go without saying — confirm that covered providers only prescribe GLP-1s for weight loss when clinically appropriate.

Emphasize clinical integration and engagement

If your GLP-1 program doesn’t integrate with your overall weight management program, it’s likely not worth the additional cost. Employees need to be educated before they start taking GLP-1s. And they should be carefully monitored by clinicians who are invested in and informed about their patients’ total health. Obesity treatment works best when it can be modified in real time — including discontinuing GLP-1s in favor of more effective medications.

The GLP-1 workforce health story is still being written

These drugs have sparked what’s been called a “weight loss revolution.” And we may be entering a new era — not just in how obesity is treated, but how it’s understood.

And as we continue learning, it’s essential for clinicians who prescribe these drugs for weight loss to be deeply invested in their patients’ total health. A collaborative, evidence-based, multi-modal approach is essential for both safety and success. Employers invested in long-term workforce wellness will simultaneously explore the emerging possibilities of GLP-1s while offering holistic, time-tested, and evidence-based weight loss support that goes beyond a prescription.


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About our expert

Sean Hashmi, MD, MS, FASN

Sean Hashmi, MD, MS, FASN, is a dedicated and experienced nephrologist and obesity medicine specialist based in Southern California. As the regional director for lifestyle and obesity medicine at Southern California Permanente Medical Group, Dr. Hashmi is responsible for building a comprehensive strategy to combat the obesity epidemic using lifestyle, pharmacotherapy, and bariatric surgery in an evidence-based, quality-driven, cost-effective manner. His innovative approach and unwavering commitment to providing evidence-based solutions have solidified his reputation as a leader in his field.

  • 1

    Sarah Berg, “With Obesity Rate Over 40%, 3 Treatment Keys for Doctors,” American Medical Association, July 20, 2023.

  • 2

    Paige Twenter, “In US, GLP-1s Cost Hundreds More than Similar Nations,” Becker’s Hospital Review, August 18, 2023.

  • 3

    See note 1.

  • 4

    See note 2.

  • 5

    Jennifer Couzin-Frankel, “Obesity Meets Its Match, 2023 Breakthrough of the Year,” Science, December 2023.

  • 6

    ”2023 Trends Shaping the Health Economy,” Trilliant Health, 2023.

  • 7

    Shohinee Sarma et al., “Weight Loss Between Glucagon-Like Peptide-1 Receptor Agonists and Bariatric Surgery in Adults with Obesity: A Systematic Review and Meta-Analysis,” Obesity, November 30, 2022.

  • 8

    See note 7.

  • 9

    Chad Terhune, “Exclusive: Most Patients Using Weight-loss Drugs Like Wegovy Stop Within a Year, Data Show,” Reuters, July 11, 2023.

  • 10

    Allison Nguyen, “What We Know About Semaglutide Adverse Events and Gastroparesis: Part 1,” Gastroenterology Advisor, September 1, 2023.

  • 11

    Peter Lin, “Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss,” Journal of the American Medical Association, October 19, 2023.

  • 12

    Noah Tong, “Omada GLP-1 Program to Prioritize Muscle Mass Restoration Through Expanded Care Track,” Fierce Healthcare, February 13, 2024.

  • 13

    Pandora Dewan, “Ozempic ‘Fatal Outcomes’ Study Raises Serious Concern,” Newsweek, February 16, 2024.

  • 14

    See note 10.

  • 15

    John Wilding et al., “Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide: The STEP 1 Trial Extension,” Diabetes, Obesity, and Metabolism, May 19, 2022.

  • 16

    Chen-Yi Yang, et al., “Cost-Effectiveness of GLP-1 Receptor Agonists Versus Insulin for the Treatment of Type 2 Diabetes: A Real-World Study and Systematic Review,” Cardiovascular Diabetology, January 19, 2021.

  • 17

    See note 15.

  • 18

    Alex Montero et al., “KFF Health Tracking Poll July 2023: The Public’s Views of New Prescription Weight Loss Drugs and Prescription Drug Costs,” KFF, August 4, 2023.

  • 19

    “Covering Weight Loss Medications in 2024 — What Employers Need to Know,” 9amHealth Survey, December 2023.

  • 20

    See note 19.

  • 21

    See note 6.

  • 22

    See note 6.